Feb 23, 2014 ... Pro OPEN C Grade. 205cc & over 2 stroke. 255cc & over 4 stroke. Pro Lites C
Grade. 125cc to 200cc 2 stroke. 250cc 4 stroke. Over 35's. Ladies.
TASMANIAN ENDURANCE RIDER’S CLUB INDEMNITY FORM
PAYMENT (Office Use Only)
**Email to send confirmation to ___________________________________ Name:___________________________________Transponder:_________________ TERC Number:________________________
Bike Type:_____________________
Emergency Contact: NAME:_________________________________
& Phone:___________________
Please TICK the class you are racing in SENIOR CLASSES Pro OPEN A Grade 205cc & over 2 stroke 255cc & over 4 stroke Pro OPEN B Grade 205cc & over 2 stroke 255cc & over 4 stroke Pro OPEN C Grade 205cc & over 2 stroke 255cc & over 4 stroke Over 35's Over 45's
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Riding Bike No
SENIOR CLASSES
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Riding Bike No
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Riding Bike No
Pro Lites A Grade 125cc to 200cc 2 stroke 250cc 4 stroke Pro Lites B Grade 125cc to 200cc 2 stroke 250cc 4 stroke Pro Lites C Grade 125cc to 200cc 2 stroke 250cc 4 stroke Ladies 125cc and above
QUAD CLASSES (Senior) QUAD A Grade QUAD B Grade
King of the Paddock (SENIORS) Note: Pro Open A / B, O/35’s & Pro Lite A grade riders only Bikes to be 125cc up. Riders must be 16yrs & over
TASMANIAN ENDURANCE RIDERS CLUB OF TASMANIA INC Page 1 of 4
Warning: This is an important document, which effects your legal rights and obligations. Read it carefully and do not sign it unless you are satisfied you understand it. Exemption / Disclaimer Clause
I am aware that observing, learning, training and participating in any motorbike racing, endurance riding otherwise known as Enduro riding, off road motorbike riding on any motor bike being used for or in connection with observing, learning, training and participating in any motorbike racing, endurance riding otherwise known as Enduro riding, off road motor bike riding on any motorbike is a dangerous undertaking and in undertaking such activities do so at my own risk.
I______________________________________________________________________ (Rider) HEREBY AGREE with the persons, organisations and bodies corporate whose name appear in Schedule 1 (hereinafter called “the organiser”) that I am by this agreement entitled to participate in the motorcycle meeting listed in Schedule 2 (hereinafter called “the meeting”) at the venue listed in Schedule 3 (hereinafter called “the Venue”) on the terms and conditions set out in this document. Acknowledgment of risks, dangers and obligations 2.
I acknowledge that motorcycle racing is dangerous and that by engaging in the sport and participation in the meeting I take I am exposed to certain risks and dangers and am under certain obligations as follows :
a) b) c) d)
That I may be injured, physically or mentally and may be killed; That my machinery or equipment may be damaged, lost or destroyed; That other competitors may ride dangerously or with lack of skill; That track or event conditions may be hazardous and may vary without warning or predictability; That organizers, officials, land owners / track operators and any agents or representatives of those in charge of race meetings are frequently obliged to make decisions under pressure of time and/or events; That any policy of or in respect of my life or physical or mental health may be avoided; That there may be no or inadequate facilities for treatment or transport of me if I am injured; That I have an obligation to myself and to others to compete safely and within the rules of this competition.
e) f) g) h)
Indemnity given to organisers
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3. In consideration of the acceptance of me as an entrant in the race meeting I agree to indemnify the organisers and each of them in the following matter, That I participate in the meeting at my sole risk and responsibility, That I accept the venue as it stands with all and any defects hidden or exposed, That I indemnify and hold harmless the organisers, their respective servants, agents or officials against any actions or claims which may be made by me or on the behalf or by any other parties for or in respect of or arising out of my death or any injury, loss or damage caused to me or my machinery or equipment whether caused by negligence, breach of contract or in any other manner whatsoever. SCHEDULES: Schedule 1 1. (Land Owner’s Name & Address): Schedule 2 Type of Meeting: Schedule 3 Race Venue: Date:
Tasmanian Endurance Riders Club of Tasmania Inc. R. Reilly Motorcycle Event (Grass Track) 1675 Oldina Road, Oldina – Gate entry at 311 Johnsons Rd. Sunday, 23rd February 2014
Permit Number
1404
Riders Signature ____________________________________________________ Third Party Indemnity where an entrant is under 18 years of age 4.I/We _________________________________________________ being the parents or guardians of the person named in clause 1 (hereinafter called “the entrant”)hereby acknowledge. a) b) c)
That I/We have read the whole document and understood it; That I/We consent to the entrant participating in the race meeting; and That I/We are aware of the risks, dangers, and obligations set out in Clause 2 hereof
5. In consideration of the entrant being accepted as an entrant in the race meeting, I/We hereby indemnify the organisers in the same manner and to the same effect as if I/We were the entrant. 6. I understand and acknowledge that by being an entrant or being a parent/guardian who has given authority hereunder to an entrant under 18 years of age attending a Tasmanian Endurance Riders Club event, myself, my children or children in my care may be photographed or videoed by other persons attending the event either as participants, members, spectators or officials. I also accept that although The Tasmanian Endurance Riders Club encourages responsible and appropriate use of images, the club cannot control the use or dissemination of images and as such they may be published in the public domain.
Parent / Guardian Signature__________________________ Date ______________ I am also aware that it is a condition of admission to membership of this event, that this club, its directors, instructors, members, servants or agents are absolved from all liability howsoever arising from injury or damage howsoever caused (whether fatal or otherwise) arising out of Page 3 of 4
membership of this club or participating in observing, learning, training and participating in any motorbike racing, endurance riding otherwise known as Enduro riding, off road motor bike riding on any motor bike, or in any way whatsoever due to any negligent act, breach of duty, default and/or omission on the part of this club, its directors, instructors, members, servants or agents, or on the part of its office bearers, directors and servants and agents. I am also aware that any person observing, learning, training, and participating in any motorbike racing, endurance riding otherwise known as Enduro riding, off road motor bike riding on any motorbike or participating in any activity carried out by this club are only allowed to do so on the distinct understanding that they do so at their own risk. I,______________________________________________________________________ Of_____________________________________________________________________ DO HEREBY ACKNOWLEDGE that of my own free will and desire I have contracted with Tasmanian Endurance Riders Club Inc. for instruction and training in motor bike riding activities which activities include observing, learning, training and participating an any motorbike racing, endurance riding otherwise known as Enduro riding, off road motor bike riding on any motor bike and that I have read and understood the warning and disclaimer above. Riders name ______________________________________________ Signed by the said rider
Sign here ___________________________________
In the presence of; Witness Signature ________________________________ (NOTE: Must be 18 yrs & over) Full Name _______________________________________ Address _________________________________________ ________________________________________________ Occupation ______________________________________
I have read this document and I understood its contents and I have signed of my own free will. ____________________________________________________ Riders Signature
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